Chronic mesenteric ischemia

Case contributed by Dr Ameen Rageh

Presentation

Chronic post-prandial vague abdominal pain, weight loss. CT requested to rule out malignancy

Patient Data

Age: 55 years
Gender: Male
CT

Contrast-enhanced abdominal CT performed at portal phase showed a filling defect in the superior mesenteric artery 5 cm from its origin causing total occlusion of its lumen and extending to its distal branches. It is associated with subsequent long segment dilated thickened wall jejunal loops which show a grey attenuation pattern and adjacent fat stranding. Minimal free fluid is also noted. Prominent vascularity of mesentery is seen suggesting flow collateralisation.

Multiple calcified atherosclerotic plaques are seen in the descending abdominal aorta and both common iliac arteries.

MIP image shows multiple distal attenuated vessels due to partial thrombosis.

 

Annotated image

Thrombosed SMA (blue arrow), thickened bowel wall (yellow arrow), prominent mesenteric vascularity (red arrow), abdominal free fluid (green arrow)

Case Discussion

Chronic mesenteric ischemia, also known as abdominal angina, is an uncommon condition, that was first described at the beginning of the 20th century, has been defined as post-prandial abdominal pain with weight loss and anorexia. 

The diagnosis of chronic mesenteric ischemia requires a high index of clinical suspicion.

The typical history is of long-standing abdominal pain starting 15-30 min post-prandially and lasting for 30 min. it is less likely to be associated with vomiting and a change in bowel habit.

In this case, based on the typical history and radiological findings the diagnosis was felt to be chronic mesenteric ischemia.

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